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Exploring the role of physician communication about adjuvant endocrine therapy among breast cancer patients on active treatment: a qualitative analysis

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Abstract

Purpose

To better understand how physicians communicate with breast cancer patients about adjuvant endocrine therapy (AET), we explored, from the breast cancer patient’s perspective, dimensions of the patient-provider communication among women who were on active AET treatment.

Methods

Qualitative methods using semi-structured in-depth interviews were conducted with breast cancer patients (n = 22) who filled a prescription for AET in the previous 12 months. Interview questions aimed to elicit experiences with AET. We reviewed and coded interview transcripts using qualitative principles of inductive reasoning to identify concepts and themes from interview data.

Results

We grouped emergent themes into four major functions of physician-patient communication: (1) information exchange, (2) decision-making to take and continue AET, (3) enabling patient self-management and monitoring potential side effects, and (4) emotional support. Physicians exchanged information with patients in a way that they understood and enhanced patient’s health literacy regarding the benefits and knowledge of AET. Physicians empowered patients to make decisions about their care. Patients expressed trust and confidence in their physician which helped them seek care when needed. Patients reported a high degree of self-efficacy to self-manage AET and were continuing treatment despite potential side effects.

Conclusions

The results from our study suggest that women’s interactions and communication with their physician may be an important factor that contributes to the continued use of AET. Physicians who can communicate information about AET treatment benefits, purpose, and expectations in a way that patients can understand is a critical aspect of care that needs to be further studied.

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Acknowledgments

The authors would like to extend our gratitude to the study participants who provided insight and perspective, and without whom this work would not be possible. This research was supported by a Ruth L. Kirschstein National Research Service Award for Individual Pre-doctoral Training grant from the National Cancer Institute F31 CA174338 (A Farias, Principal Investigator). This work was also supported in part by a Postdoctoral Fellowship, University of Texas School of Public Health Cancer Education and Career Development Program- National Cancer Institute/NIH Grant R25 CA57712. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.

Author information

Authors and Affiliations

  1. Department of Health Services, University of Washington, Seattle, WA, USA

    Albert J. Farias, India J. Ornelas, Steven B. Zeliadt & Beti Thompson

  2. School of Public Health, Department of Epidemiology and Human Genetics, University of Texas Health Sciences Center Houston, 1200 Pressler St., Suite E633, Houston, TX, 77035, USA

    Albert J. Farias

  3. Fred Hutchinson Cancer Research Center, Public Health Sciences Division, Seattle, WA, USA

    Sarah D. Hohl, Christopher I. Li & Beti Thompson

  4. Department of Veterans Affairs Puget Sound Health Care System, Health Services Research and Development Center of Excellence, Seattle, WA, USA

    Steven B. Zeliadt

  5. Department of Pharmacy, University of Washington, Seattle, WA, USA

    Ryan N. Hansen

  6. University of Washington, Department of Epidemiology, Seattle, WA, USA

    Christopher I. Li

Authors
  1. Albert J. Farias
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  2. India J. Ornelas
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  7. Beti Thompson
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Corresponding author

Correspondence to Albert J. Farias.

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Ethical approval

All procedures performed in this study involving human participants were in accordance with ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The authors declare that they have no conflicts of interest.

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Appendix: Adherence to Adjuvant Endocrine Therapy among Breast Cancer Survivors: Qualitative Instrument

Appendix: Adherence to Adjuvant Endocrine Therapy among Breast Cancer Survivors: Qualitative Instrument

Cancer diagnosis and initial treatment experience

  1. 1.

    Will you describe the type of cancer you have?

  2. 2.

    What do you think caused your breast cancer?

  3. 3.

    Where did you have your treatment for breast cancer?

  4. 4.

    What type of medical treatment did you have for your breast cancer?

  5. 5.

    What were the options that your doctor gave you for your treatment?

  6. 6.

    Alongside the medical care your doctor gave you, did you use any other traditional medicine, such as acupuncture, herbs, etc. to treat your cancer?

  7. 7.

    Can you describe for me how your doctors and nurses treat you?

  8. 8.

    Where did you find emotional support or comfort for your emotions during the time you were going through treatment?

  9. 9.

    Is there anything that would have helped you to better deal with your cancer diagnosis and treatment?

Cancer survivorship and long-term adjuvant treatment

After receiving treatment, some people experience being very tired, have pain, or trouble with their memory, do you have any of these?

Adjuvant hormonal therapy

  1. 10.

    Are you currently going to the doctors for your breast cancer?

  2. 11.

    Are you currently taking any medication for your breast cancer? [Tamoxifen, anastrozole (arimidex), exemestane, letrozole]

  1. I.

    How often do you take these pills?

  2. II.

    What, if any, side-effects do you have from these treatment(s)?

  3. III.

    Has your doctor ever told you how long you should be taking these medications?

  4. IV.

    How confident do you feel that you will be able to continue with the treatment?

  1. 12.

    What did your doctor tell you were the benefits of taking the medication?

  2. 13.

    What do you believe are the benefits of taking the medication?

  3. 14.

    Why are you continuing with your treatment?

  4. 15.

    How difficult is it for you to regularly take medication for your breast cancer?

  5. 16.

    What made you decide to receive additional treatment?

  6. 17.

    What has your doctor told you that you should do to keep your cancer from coming back?

  7. 18.

    How would you feel if your doctor prescribed for you to take a pill once a day for up to 5 years to help your cancer from coming back?

  8. 19.

    Has your doctor told you how often you should see him/her or another doctor?

  9. 20.

    What would be the most challenging thing to keep you from taking the medication?

  10. 21.

    Do you ever think about the cancer coming back?

  11. 22.

    Is there anything else that you would like to talk about with your doctor regarding your cancer?

  12. 23.

    People who have had cancer often call themselves “cancer survivors”. Do you see yourself as a cancer survivor?

Sociodemographic

  1. 24.

    Where were you born?

  2. 25.

    How many years have you lived in this country? _____________ years

  3. 26.

    Are you:

  1. a.

    married or living as married

  2. b.

    single

  3. c.

    divorced

  4. d.

    widower

  1. 27.

    What is your household composition?

  2. 28.

    What is the highest level of education you completed?

  1. a.

    no education or kindergarten

  2. b.

    elementary school (1–6)

  3. c.

    middle school

  4. d.

    high school diploma or equivalent (GED)

  5. e.

    some college, Associate’s degree, Vocational or Technical College

  6. f.

    Bachelor’s degree

  7. g.

    Master’s or doctoral degree

  1. 29.

    Please tell me into which category your total household income for one year falls.

  1. a.

    Less than $15,000

  2. b.

    $15,000 to less than $20,000

  3. c.

    $20,000 to less than $25,000

  4. d.

    $25,000 to less than $30,000

  5. e.

    $30,000 to less than $35,000

  6. f.

    $35,000 to less than $40,000

  7. g.

    $40,000 to less than $45,000

  8. h.

    $45,000 to less than $50,000

  9. i.

    $50,000 or more

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Farias, A.J., Ornelas, I.J., Hohl, S.D. et al. Exploring the role of physician communication about adjuvant endocrine therapy among breast cancer patients on active treatment: a qualitative analysis. Support Care Cancer 25, 75–83 (2017). https://doi.org/10.1007/s00520-016-3389-6

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  • DOI: https://doi.org/10.1007/s00520-016-3389-6

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